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Official websites use. Share sensitive information only on official, secure websites. Suite , Emeryville, CA This study examined patterns of smoked substances cigarettes and marijuana among heterosexuals, gays, lesbians, and bisexuals based on data from the National Alcohol Survey NAS , a population-based telephone survey of adults in the United States. Sexual orientation was defined as: lesbian or gay self-identified, bisexual self-identified, heterosexual self-identified with same-sex partners in the last five years, and exclusively heterosexual heterosexual self-identified, reporting no same sex partners. Findings indicate that bisexual women and heterosexual women reporting same-sex partners had higher rates of cigarette smoking than exclusively heterosexual women. Bisexual women, lesbians and heterosexual women with same-sex partners also used marijuana at significantly higher rates than exclusively heterosexual women. Marijuana use was significantly greater and tobacco use was elevated among gay men compared to heterosexual men. SSImp was associated with greater use of both of these substances across nearly all groups. Bar patronage and SSImp did not buffer the relationship between sexual identity and smoking either cigarettes or marijuana. These findings suggest that marijuana and tobacco use differ by sexual identity, particularly among women, and underscore the importance of developing prevention and treatment services that are appropriate for sexual minorities. Keywords: sexual orientation, tobacco use, marijuana use, sensation-seeking, bar patronage. Estimates of sexual minorities in the U. Understanding disparities in risk for substance use among diverse populations, including sexual minorities, is important to informing effective prevention and intervention efforts GLMA, Population-based studies of smoking and sexual orientation generally suggest higher smoking risk among sexual minority groups. Although these studies have used different definitions of smoking risk and different measures of sexual orientation e. While a few studies with probability samples found no differences or mixed results by sexual orientation Bowen et al. Some studies of college students in the U. Although few studies have been conducted that examine explicitly the factors that may underlie high rates of both smoking and marijuana use among lesbian, gay, and bisexual populations, there is an emerging literature that explores underlying mechanisms. However, other factors that contribute to tobacco and marijuana use may differ by gender among sexual minorities. Hughes and Jacobson found that in addition to risks associated with greater rates of depression and target marketing, sexual minority women were more likely than heterosexuals to have a partner who smoked and that multiple marginalized statuses increased odds of lifetime and current smoking. Elevated tobacco and marijuana among lesbian and bisexual women may be associated with gender atypicality e. However, few population-based studies examine the relationship between bar patronage and smoking tobacco or marijuana among sexual minorities. For example, Kendall and Prescott's extensive analysis of twin data, found that temperament patterns interact with the severity of negative life events in predicting outcomes such as mood disorders or substance use. These possible relationships are of particular interest in the context of research documenting the impact among sexual minorities of exposure to stressors such as social disapproval, discrimination, and other negative life events Meyer, Exploring possible relationships between temperament factors, such as sensation-seeking and impulsivity, and substance use among diverse populations including sexual minorities, may help to refine our understanding of differences in risk. Among U. Many of the population-based studies examining sexual orientation and tobacco or marijuana use are based on regional or college populations and, consequently, may be limited in generalizability to larger populations. In addition, few national population based studies disaggregate lesbians and gay men from bisexual respondents. Although tobacco use is legal and marijuana use is considered an illicit substance, both substances may impact health and the higher rates of use among sexual minority women and men suggested by prior studies warrant further investigation. A study using a national population sample is important to overcome potential biases in previous studies of sexual orientation and prevalence correlates of smoking and marijuana use using regional samples or samples drawn from health or educational institutions. Furthermore, there is a need for national population based research that controls for key characteristics that may be associated with heavier use such as sensation-seeking and frequent bar patronage. The data used for this study are from the National Alcohol Survey conducted from November through June , a national household computer assisted telephone interview CATI survey of the adult 18 or older population in all 50 states of the US and Washington D. Random Digit Dialing RDD was used to develop the sample with list-assisted number generation, automatic detection of non-working numbers, and computer matching against yellow pages to increase the hit rate. Sampling was done using the last birthday technique, that is, the target respondent is chosen on the basis of the person who most recently had a birthday. A Spanish version was administered to Spanish speakers. Interviews lasted minutes depending on the drinking status of the individual. Considerable pre-testing and extensive interviewer training was conducted, and efforts were made to minimize non-response through intensive callback and non-response conversion efforts. The response rate was 58 percent. Since earlier National Alcohol Surveys and earlier had been face-to-face surveys, several methodological sub-studies were done to ensure comparability of data when we shifted modes in Demographic variables include: gender, age , , 50 or older , ethnicity White, Black, Hispanic, Other , relationship status partnered or not partnered , and educational level high school or less, greater than high school. Respondents were asked how often they used marijuana in the past twelve months once a week or more often, once every two or three weeks, once every month, less often than that or never. For analysis, the question was dichotomized into never versus any use in the past year. Tobacco use was also defined by any use in the past year. Respondents were asked about lifetime use of cigarettes or other tobacco. This was followed by questions about frequency of use and whether the tobacco use consisted of cigarettes only, other tobacco or both. Finally, respondents who smoked were asked how many cigarettes they smoked each day. This study employs the same four-category sexual orientation variable to examine tobacco and marijuana use. More women than men refused to answer the behavior question 3. The scale has a high reliability of. Sensation seeking and impulsivity constructs are sometimes considered separately but the short scale in the National Alcohol Survey combines to a single factor. Zuckerman and Kuhlman also have a single scale factor which combines impulsivity and sensation-seeking ImpSS which they have used in studies of risky behavior and substance use. Since the scale used in this study also combines impulsivity and sensation seeking, SSImp is used to distinguish it from the Zuckerman and other scales. Examples of impulse control items include: I often act on the spur-of-the-moment without stopping to think or I get a real kick out of doing things that are a little dangerous. Items tapping sensation-seeking includes: I'm always up for a new experience; I go for the thrills in life when I get a chance. Responses are on a four category Likert-type scale ranging from 3 to 0 would you say that this statement describes you quite a lot, some, a little or not at all. The items were summed with the high end representing higher SSImp and divided into very low, low, high and very high groups on the basis of population quartiles. Respondents in the highest quartile are compared to all other groups combined. As part of a scale that assesses the social contexts of alcohol use, respondents were asked how often they went to bars, taverns or cocktail lounges during the past year? All analyses were conducted separately by gender. Bivariate analyses were conducted to examine the distribution for each of the criterion cigarette use and marijuana use and the predictor variables all others by sexual identity group using chi-square tests and follow up tests for between group comparisons. All analyses were conducted separately for women and men. Logistic regressions were conducted separately for women and men. We also ran the logistic regressions with only the criterion variable and the sexual identity variables entered to see the relative change when adjusted by demographics, SSImp and bar patronage. We first entered the sexual orientation variable, then the demographic block and finally SSimp and bar patronage. The analyses reported here were weighted, which corrects for unequal probability of selection in larger versus smaller households and adjusts for any differences in age, sex, and region of the country. Analyses also controlled for sampling design effects Stata Corp. Since the analyses were virtually identical, the SPSS data are presented. Table 1 presents a demographic description of the study sample. Sexual orientation groups were created using an item asking about self-identity and one on behavior. Among women, bisexual women were significantly younger and less likely to be in a partnered relationship than the other three groups. The four groups of men did not differ from one another on age but they did differ on other demographic variables. Exclusively heterosexual men were more likely to report being in a partnered relationship compared to the three other groups. Gay men were more likely to report having more than a high school education compared to both exclusively heterosexual men and heterosexual identified men reporting same-sex partners. Overall, Table 1 shows the bivariate results for tobacco use. Chi-square analyses found significant differences by sexual orientation in the proportion of women who smoked cigarettes. Heterosexual women were the least likely to be smokers By contrast, Table 1 also shows the results for marijuana use. In this instance, chi-squared analyses found significant differences in marijuana use across the four groups of women. The statistics represent the proportion of individuals who were in the highest quartile on the SSImp variable. In contrast, proportionately more men were in the highest quartile Table 1 also shows the proportion of our sample who go to bars once a month or more across the four different sexual identity groups. Table 2 shows the final odds ratios after all variables have been entered. The first column shows the multivariate logistic regression results for cigarette smoking for women. Bisexual women and heterosexual women with same-sex partners smoked more than exclusively heterosexual women after all the other variables have been entered. This is consistent with the unadjusted odds ratios reported earlier where, again, lesbians did not have higher odds of smoking than heterosexual women. With respect to other demographic variables, those women who were older over 50 , those who were better educated and those of Black or Latino ethnicity smoke less; those who were single, higher on sensation seeking and frequent bar patrons smoke more. Note: The odds ratios and confidence intervals for education, sensation seeking and bar-going are identical for both men and women where tobacco smoking is the dependent variable. This was checked to ensure that it was not a mistake. The numbers are different before rounding e. For men, sexual identity was associated with tobacco use only among gay men compared to heterosexual men, and that was at the margin of significance. It is notable that this is the same odds ratio as reported earlier for the unadjusted association indicating that none of the other demographic variables affected this association. The relationship between the other demographics and tobacco use were similar to the findings for women with one exception. Latina women were less likely to use tobacco than white women but this tendency did not achieve significance among Latino men compared to white men. For marijuana use, exclusively heterosexual women were significantly less likely to use marijuana compared to the other three groups of women. Those women who were not partnered, who were high on sensation seeking, and those who reported more frequent bar patronage were also more likely to use marijuana. The odds for marijuana use were lower among older age groups. Education and ethnicity were not significant predictors among women. Gay men were significantly more likely to use marijuana than exclusively heterosexual men; no other differences by sexual identity were significant as was the case in the unadjusted analyses reported earlier. Men who were single, better educated, higher on sensation seeking and frequent bar patrons were more likely to use marijuana. As with women, older age was a protective factor. Bar patronage and SSImp have independent and significant effects on both cigarette smoking and marijuana use. Even controlling for other demographic variables, the odds of both tobacco and marijuana use were higher among respondents in the highest quartile of the SSImp score compared to respondents with lower scores. The odds of both tobacco and marijuana use were also significantly higher among respondents who patronized bars once a month or more compared to respondents who patronized bars less frequently. We also conducted a series of analyses to examine whether bar patronage and SSImp might mediate the relationship between sexual identity and the two criterion variables of tobacco smoking and marijuana use. Tables showing iterations of the logistic regression model are not shown because the mediating effect of both bar patronage and SSImp on the association between the predictor variables and the criterion variables is very small, only occurs for women, and does not change significance of relationships in the full model depicted in Table 2. The overall rates of smoking tobacco among respondents in our study were similar to findings for the National Health Interview Survey National Center for Health Statistics, Although most population based studies suggest that smoking is also higher among both lesbians and gay men Burgard et al. Our findings are consistent with other population-based studies that find higher rates of marijuana use among sexual minority women and men compared to heterosexual men and women Cochran et al. Specifically, we found higher rates of marijuana use among gay men and among lesbian, bisexual, and heterosexual identified women who had sex with women compared to exclusively heterosexual respondents. In our study, women who identified as bisexual, as well as heterosexual women who reported same-sex partners, also had odds for tobacco use that were substantially higher than that of exclusively heterosexual women. Measures of sensation seeking and bar patronage were, as expected, significantly associated with tobacco smoking and marijuana use among both women and men. Analyses of differences in sensation seeking and bar patronage by sexual orientation found consistent and strong differences among women. Specifically, rates of frequent bar-patronage and classification as high on the sensation seeking scale were significantly lower for exclusively heterosexual women compared to lesbians, bisexuals, and heterosexual-identified women reporting same-sex partners. Bar patronage was significantly different among men, with gay men reporting particularly frequent bar patronage. This research does not yet fully explain why there appear to be differences in sensation seeking across sexual identity groups for women. Authors of one study of addictive behavior gambling and sexual orientation speculated that biological differences in sensation-seeking by gender may explain variations in risky behaviors Hershberger and Bogaert, However, although sensation seeking is often conceptualized as a biological factor that may create vulnerability to substance use and abuse Zuckerman, b , the direction of the relationship between sensation-seeking and substance abuse may be more complex. Kendler and Prescott note that women seem to be more susceptible than men to negative behavioral outcomes if they are more extreme on temperament characteristics such as novelty seeking. The interactions between biology, stress, and environmental factors on both temperament and substance use may be particularly salient to sexual minorities given disproportionate stressors, experience of violence, and heavier alcohol and drug use among adolescents see Hegna et al. Meyer's minority stress model explains how stigma, prejudice, and discrimination contribute to increased risk of substance abuse and other mental health problems among sexual minorities. Stress responses appear to differ by gender and personality characteristics such as sensation seeking may help to buffer stress Roberti, We know little about how these factors may further differ by sexual orientation or about how broader environmental contexts may impact both stress and drinking. The authors note that social and cultural factors, such as the level of public acceptance and visibility of sexual minorities, may influence the level of stress and subsequent drinking behaviors associated with individual processes of developing identity, disclosing sexuality, and creating community. The current data, while having the advantage of national representativeness and a probability sample, still have limitations. The data were gathered in ; although overall trends in smoking may have changed, our finding of differences by sexual identity generally appear to be consistent with other recent studies. Gay men, lesbians and bisexuals are subject to discrimination and social disapproval, thus making it possible that some respondents might not have disclosed sexual orientation information over the phone. This suggests that disclosing non-heterosexual identity may remain sensitive, particularly for older survey respondents, even in anonymous telephone surveys. Furthermore, the numbers of respondents in sexual minority groups in this population based survey are small. It is possible that our finding of elevated but not significantly greater smoking among gay men and lesbians compared to exclusively heterosexual men and women may be related to the small numbers of respondents in these categories in our sample. It may be that larger studies with greater sample sizes, or oversamples of sexual minority populations, are needed to verify these findings. A clear understanding of disparities in smoking risks among lesbians and gay men will be made possible only as sexual identity demographic variables are routinely included in health surveillance surveys. Despite these limitations, the study does support a growing body of literature suggesting differential risks for tobacco and marijuana use among sexual minority populations, particularly among women. The importance of environmental prevention strategies would also appear to be supported by the finding that bar patronage was associated with smoking and marijuana use among all women as well as marijuana use among gay men. Findings from this study also underscore the importance of advancing population-based research that is inclusive of sexual orientation, particularly research that may foster a greater understanding of factors that may contribute to health disparities among sexual minority populations. Publisher's Disclaimer: The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. The published version is available at www. As a library, NLM provides access to scientific literature. Psychol Addict Behav. Published in final edited form as: Psychol Addict Behav. Find articles by Karen F Trocki. Laurie A Drabble , Ph. Find articles by Laurie A Drabble. Lorraine T Midanik , Ph. Find articles by Lorraine T Midanik. PMC Copyright notice. The publisher's version of this article is available at Psychol Addict Behav. Open in a new tab. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Exclusively heterosexual 1. White 1. Partnered 1. High school or less 1. Less than 1 per month 1.