Cigarette Smoking Cessation in Adolescents & Young Adults: Associations with Sexual Orientation

Objective: High prevalence of cigarette smoking among youth with a same-sex sexual orientation is likely due to elevated smoking uptake coupled with low cessation rates. Few studies have examined smoking cessation by sexual orientation in youth.

Methods: We used self-administered questionnaire data from participants of the Growing Up Today Study followed annually or biennially from ages 12-29 years who reported smoking in the past year (N=7365). Smoking cessation behaviors (intention to quit, attempt to quit, and successfully staying quit) of lesbian/gay, bisexual, and mostly heterosexual youth were compared to those of completely heterosexual youth using repeated measures multivariable regression stratified on gender. Age, race/ethnicity, and region of residence were included as potential confounders. Mediation by nicotine dependence and number of friends who smoke was also examined.

Results: Among female past-year smokers, lesbians, bisexuals, and mostly heterosexuals were less likely than completely heterosexuals to report an intention to quit in the next year (Adjusted Odds Ratios (AORs)=0.69-0.87; Ps<.03) and a successful quit outcome (AORs=0.56-0.78; Ps<.01). Among males, there were no sexual-orientation differences in intention to quit; mostly heterosexuals were less likely than completely heterosexuals to report a successful quit outcome (AOR=0.70; P=.005). In females, greater nicotine dependence and friends’ smoking among sexual minorities partly explained their lower likelihood of having a successful quit outcome.

Discussion: Sexual orientation minorities have poorer smoking cessation outcomes during adolescence and young adulthood compared with completely heterosexuals; disparities are more pronounced in females than males. Cessation efforts should target this population.