Sexual Orientation-Related Differences in Tobacco Use and Secondhand Smoke Exposure Among US Adults Aged 20 to 59 Years: 2003-2010 National Health and Nutrition Examination Surveys

Am J Public Health. 2013 Oct;103(10):1837-44. doi: 10.2105/AJPH.2013.301423. Epub 2013 Aug 15.


Objectives: We investigated sexual orientation-related differences in tobacco use and secondhand smoke (SHS) exposure in a nationally representative sample of US adults.

Methods: The 2003-2010 National Health and Nutrition Examination Surveys assessed 11 744 individuals aged 20 to 59 years for sexual orientation, tobacco use, and SHS exposure (cotinine levels ≥ 0.05 ng/mL in a nonsmoker). We used multivariate methods to compare tobacco use prevalence and SHS exposure among gay or lesbian (n = 180), bisexual (n = 273), homosexually experienced (n = 388), and exclusively heterosexual (n = 10 903) individuals, with adjustment for demographic confounding.

Results: Lesbian and bisexual women evidenced higher rates of tobacco use than heterosexual women. Among nonsmokers, SHS exposure was more prevalent among lesbian and homosexually experienced women than among heterosexual women. Nonsmoking lesbians reported greater workplace exposure and bisexual women greater household exposure than heterosexual women did. Identical comparisons among men were not significant except for lower workplace exposure among nonsmoking gay men than among heterosexual men.

Conclusions: Nonsmoking sexual-minority women are more likely to be exposed to SHS than nonsmoking heterosexual women. Public health efforts to reduce SHS exposure in this vulnerable population are needed.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Confidence Intervals
  • Environmental Exposure / statistics & numerical data
  • Female
  • Health Surveys
  • Humans
  • Male
  • Middle Aged
  • Odds Ratio
  • Prevalence
  • Sexuality*
  • Smoking / epidemiology*
  • Tobacco Smoke Pollution / statistics & numerical data*
  • United States / epidemiology
  • Young Adult


  • Tobacco Smoke Pollution